Mental disorders and COVID-19 deaths: Clinical, public health, and human rights implications
Authors: Shekhar Saxena, Cindy Chwa
Journal: PLoS Medicine (2023)

Given the staggering death toll from the CoronavirusAU : Pleasenotethat}COVID À 19}hasbeenfullyspDisease 2019 (COVID-19) pandemic, numerous studies have investigated risk factors and care strategies for prevention and treatment.While many observational studies have documented COVID-19-related risk, outcomes, and care cross-sectionally or over a short follow-up period, there is a paucity of longitudinal studies examining COVID-19-associated outcomes across multiple waves of the pandemic, as well as whether the association between preexisting mental disorders and a COVID-19 diagnosis is a result of confounding.With prior longitudinal cohort studies suggesting that preexisting mental disorders are associated with increased mortality from various severe illnesses [1], it is imperative that this research gap is addressed.In an accompanying paper in PLOS Medicine, Schwarzinger and colleagues investigated the association between preexisting mental disorders and mortality due to COVID-19 in France, controlling for salvage therapy (higher intensity, rescue treatment given after standard treatments have failed) [2].Using the French National Hospital Discharge database, Schwarzinger and colleagues assessed mortality among a cohort of adults discharged from acute hospitals with a COVID-19 diagnosis from February 24, 2020 to August 28, 2021 (N = 465,750).All participants in this study were followed for 120 days after their first recorded COVID-19 diagnosis, and all-cause mortality data were taken from acute, post-acute, and psychiatric hospitals.Salvage therapy was assessed by first record of intensive care unit admission, oxygenation, respiratory support, or airway pressure therapy during the follow-up period.Four wave periods were considered to investigate the role of COVID-19 caseload surges on prognosis.Nearly all categories of mental disorder in the study were associated with higher mortality risk and lower salvage rates.Caseload surges in hospitals were associated with a significantly greater increase in excess mortality risk among patients with mental disorders compared to those without.For the majority of the study period, patients without a preexisting mental disorder accessed salvage therapy at higher rates than expected (+4.2%, for a predicted rate of 18.8%) and those with a preexisting mental disorder at lower rates than expected (-4.1%, for a predicted rate of 18.0%).Their finding of a higher mortality rate among people with preexisting mental disorders is in agreement with earlier studies from other countries [3], but this new study adds value through its large sample and longitudinal design, accounting for a substantial number of confounders and analyzing access to salvage therapy, which has been less often reported.Factoring in severe somatic comorbidities is a notable strength, since this can be a significant confounder.Over the duration of COVID-19 pandemic, various risk factors have been identified for infection, severe illness, and death [4].Preexisting mental disorders were identified relatively